Risk Factors for Acute Kidney Injury in Patients Undergoing Orthopedic Surgery

Summary and Comment |
December 3, 2015

Risk Factors for Acute Kidney Injury in Patients Undergoing Orthopedic Surgery

  1. Paul S. Mueller, MD, MPH, FACP

Predictors of postoperative AKI include older age, male sex, and use of ACE inhibitors and ARBs.

  1. Paul S. Mueller, MD, MPH, FACP

Acute kidney injury (AKI) after surgery is associated with excess risk for death. In this study, researchers developed and validated a model for predicting AKI following orthopedic surgery. Analysis involved 10,600 adults (mean age, 71) who underwent orthopedic surgery in Scotland from 2005 through 2011; 6200 patients were in the development group, and 4400 were in the validation group. Mean baseline estimated glomerular filtration rate (eGFR) in both groups was 71 mL/minute/1.73 m2.

Postoperative AKI occurred in 11% of patients in the development group and in 7% of the validation group. Seven predictors of AKI were identified: older age, male sex, diabetes, lower eGFR, use of angiotensin-converting–enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), larger number of prescribed drugs, and higher American Society of Anesthesiologists grade. Both short-term and long-term survival were lower in patients with AKI than in those without AKI.

Comment

This study affirms what experienced clinicians know: Older age, diabetes, baseline renal insufficiency, and comorbidity are associated with greater risk for AKI after orthopedic surgery, and AKI, in turn, is associated with higher mortality. In addition, perioperative use of ACE inhibitors and ARBs was associated with excess risk for AKI, but whether these drugs should routinely be withheld perioperatively is controversial.

Editor Disclosures at Time of Publication

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Editorial boards Medical Knowledge Self-Assessment Program (MKSAP 17 General Internal Medicine Committee); MKSAP 17 General Internal Medicine (author/contributor) Leadership positions in professional societies American Osler Society (Vice President)

Citation(s):

Reader Comments (2)

Sal Obaid Physician, Critical Care Medicine, Clinic and ICU

It is malpractice not to withhold ACE and ARB's before any general anesthesia.best result accomplished by holding these drugs 48 h before and several days after surgery.only resume it when pt are eating well,feelin and ambulating well.Any one seen
Pt with post op syncope?these drugs are usually the culprit!!!

Sal Obaid Physician, Critical Care Medicine, Office and ICU

When we already know that ACE and ARB's increase the incidence of AKI and probably mortality,then what is the reason not to withhold these drugs preoperativly?
I have been doing that for 20 years,and never felt regrets,
Can you say the same?

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.